Provider Demographics
NPI:1407864077
Name:SUFFERN, JENNIFER LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:SUFFERN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:16834 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6032
Mailing Address - Country:US
Mailing Address - Phone:708-364-1384
Mailing Address - Fax:312-864-9165
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:ORTHO OFFICE ROOM 657
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-5365
Practice Address - Fax:312-864-9755
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005076213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist